Muscle repair
Your photo and description suggest that a muscle repair would be beneficial. However, if you are sure you are going to have another pregnancy, doing a tummy tuck at this time doesn’t make a lot of sense.
It would be to your benefit to wait until you are done having children before going through the risk and cost of a tummy tuck procedure. (Michael S. Hopkins, MD, Albuquerque Plastic Surgeon)
Do I need a muscle repair?
Almost all women who have had multiple pregnancies would benefit from a muscle repair at the time of a tummy tuck.
It would be best to wait until after you are done having children before you have a tummy tuck so that you do not re stretch your skin and muscles and undo what the tummy tuck has accomplished. However, if the excess skin from your weight loss is more than you can live with, and you recognize that you very well may require another tummy tuck after you are done having children, then I suppose you can go ahead with your planned tummy tuck, though I would recommend not having a muscle repair if you are planning future pregnancies. (Robert M. Grenley, MD, Seattle Plastic Surgeon)
Whether or not you need muscle repair at the time of the abdominoplasty can only be determined by examination. But if the spread is only 1 cm as you say, there is little to no gain in tighteneing the muscles. (Ronald V. DeMars, MD, Portland Plastic Surgeon)
Muscle Repair Probably Necessary
You would probably need muscle repair since you’ve had three children and lost a good deal of weight (congrats on the weight loss, by the way!). If you are concerned about your surgeon’s assessment, please see another surgeon for a different opinion. Also, I agree that you should wait until after having your child to proceed with a tummy tuck. (Jerome Edelstein, MD, Toronto Plastic Surgeon)
Muscle plication
Almost all women will benefit from plication of the abdominal wall after pregnancy. This will give you the flattest result. Honestly, if you plan to have another child, I would hold off the abdominoplasty for now. Most of your results will be lost after future pregnancy. (Shim Ching, MD, Honolulu Plastic Surgeon)
Any patient that had 3 kids and a 90 pound weight loss will benefit tremendously from a plication (muscle repair). Your muscle outline shows that your abdominal wall is lax. I wouldn’t consider a tummy tuck without a plication. But, if you are going to have another baby, you should do the procedure afterwards. (Stephen J. Ronan, MD, FACS, San Francisco Plastic Surgeon)